The real reasons why women are going without their HRT?

February 7, 2020

“My pharmacist just says it’s out of stock, that’s it”
“I’ve been left to go from store to store checking which chemist might have it”
“I’ve been given something completely different and it does not suit me”

There have been shortages of HRT products for many months now. First tablets went out of stock, then patches, and before long many of the most commonly prescribed HRTs were completely absent from shelves. Women were left to knock on the doors of pharmacies far and wide and some even resorted to going to Spain to buy their HRT.

Speculation was rampant. Was it the manufacturers? Was it the wholesalers? Was it pre-Brexit stockpiling? Was it the NHS itself?

Yet, if you were to speak to those of us who regularly prescribe HRT, it was rare for our patients to go without HRT.

Did we have secret supplies?

No, we simply knew how to access other HRTs that were very similar or as good as those HRTs that were not available. Yes, gels and tablets may not be as convenient as a single patch, but they offered better alternatives than using nothing. A change in brands occasionally led to minor side-effects or a change in bleeding pattern, but on the whole women appreciated the chance to try a close equivalent to their usual medication.

The simple fact is that no-one needed to go without any HRT at all.

Yet all over the UK, women were not offered alternatives. They were basically told to be patient until stocks resumed, to just get on with it.

So, as we start to see the return of many HRT products that were previously hard to find, let’s consider two of the main reasons why thousands upon thousands of women were left high and dry.

1. Inadequate HRT knowledge among many healthcare professionals.

It’s clearly the responsibility of applicable healthcare professionals to have a suitably in-depth knowledge of HRTs. After all, menopause impacts a huge proportion of their patients and NICE guidelines recommend HRT as the most effective way to manage bothersome symptoms.

Yet many healthcare professionals knew only one or two products and often had no concept of the constituents and nuances of each HRT. They didn’t know what makes one product different or similar to another product, or which doses were equivalent to other doses. They therefore weren’t in a position to suggest alternatives. I expect that some didn’t even know that certain HRTs could be substituted for other HRTs in the first place.

The information was readily available: the British Menopause Society and others produced guidance. We at Peppy published this guidance in August last year. I even spoke about the alternatives on BBC breakfast TV.

But it didn’t seem to make a big difference. Many professionals didn’t seem to know where to look for this information or how to access it. It was left to women to do their own research and show their GPs what they had found.

2. Women struggled to access personalised menopause advice

Women frequently report that it’s hard to get the personalised advice needed for menopause at the best of times. During the HRT shortage, this became even more apparent.

Women turned to social media and to non-medical websites, not just for support and information, but for personal medical advice. Some sites were better than others at limiting content to general rather than personal advice. But nonetheless many desperate women were given specific prescribing advice in great depth, by individuals without the qualifications and experience to provide advice safely.

Many of us involved in the clinical world of menopause have campaigned for years to make personalised menopause advice more accessible. So, seeing the same problems magnified during the HRT shortages crisis was particularly disappointing.

As we move on from the saga of HRT shortages, we need to learn from it. We need to ensure that HRT prescribers have a greater knowledge than just one or two products, that they can switch appropriately and offer a choice. When it comes to HRT, one size does not fit all.

Women need improved access to personalised menopause support; we need practitioners to step up and guide women through the system, to be proactive, make a management plan with them as partners and help them to make choices that are right for them, even when times are tricky.

The absence of adequate HRT knowledge and access to personalised support were, I feel, the real reasons why women ended up without HRT.